Industrial Wind Turbines and Health: Wind Turbines Can Harm Humans if too close to Residents 1

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1 Industrial Wind Turbines and Health: Wind Turbines Can Harm Humans if too close to Residents 1 A summary of some of the peer reviewed articles and conference papers, abstracts and other citations, regarding impairment of health in general and relating to industrial wind turbines 2 PEER REVIEWED Compiled by Carmen Krogh, BScPharm April Ambrose, Stephen E.; Rand, Robert W.; and Krogh, Carmen M. E. Wind Turbine Acoustic Investigation: Infrasound and Low-Frequency Noise A Case Study DOI: / Bulletin of Science Technology & Society published online 17 August Wind turbines produce sound that is capable of disturbing local residents and is reported to cause annoyance, sleep disturbance, and other health-related impacts. An acoustical study was conducted to investigate the presence of infrasonic and low-frequency noise emissions from wind turbines located in Falmouth, Massachusetts, USA. During the study, the investigating acousticians experienced adverse health effects consistent with those reported by some Falmouth residents. The authors conclude that wind turbine acoustic energy was found to be greater than or uniquely distinguishable from the ambient background levels and capable of exceeding human detection thresholds. The authors emphasize the need for epidemiological and laboratory research by health professionals and acousticians concerned with public health and well-being to develop effective and precautionary setback distances for industrial wind turbines that protect residents from wind turbine sound. Arra I, Lynn H, Barker K, et al. ( :51:41 UTC) Systematic Review 2013: Association between Wind Turbines and Human Distress. Cureus 6(5): e183. doi: /cureus Background and Objectives: The proximity of wind turbines to residential areas has been associated with a higher level of complaints compared to the general population. The study objective was to search the literature investigating whether an association between wind turbines and human distress exists. Methods: A systematic search of the following databases (EMBASE, PubMed, OvidMedline, PsycINFO, The Cochrane Library, SIGLE, and Scirus) and screening for duplication led to the 1 Excerpted from Case Nos.: / Erickson v. Director, Ministry of the Environment Environmental Review Tribunal, Decision, p 207 This case has successfully shown the debate should not be simplified to one about whether wind turbines can cause harm to humans. The evidence presented to the Tribunal demonstrates that they can, if facilities are placed too close to residents. The debate has now evolved to one of degree. 2 This summary focuses on references 2010 to April 2015 associated with risks to health. References are not intended to be exhaustive. 3 Any errors or omissions are unintended 1

2 identification of 154 studies. and full article reviews of these studies led to the identification of 18 studies that were eligible for inclusion as they examined the association of wind turbines and human distress published in peer-review journals in English between Outcome measures including First Author, Year of Publication, Journal Name, Country of Study, Study Design, Sample Size, Response Rate, Level of Evidence, Level of Potential Bias, and Outcome Measures of Study were captured for all studies. After data extraction, each study was analyzed to identify the two primary outcomes: Quality of Study and Conclusion of Study Effect. Results: All peer-reviewed studies captured in our review found an association between wind turbines and human distress. These studies had levels of evidence of four and five. Two studies showed a dose-response relationship between distance from wind turbines and distress, and none of them concluded no association. Conclusions: In this review, we have demonstrated the presence of reasonable evidence (Level Four and Five) that an association exists between wind turbines and distress in humans. The existence of a dose-response relationship (between distance from wind turbines and distress) and the consistency of association across studies found in the scientific literature argues for the credibility of this association. Future research in this area is warranted as to whether or not a causal relationship exists. Bakker RH, E. Pedersen E, van den Berg, GP, Stewart RE, Lok W, Bouma J Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress Science of the Total Environment 425 (2012) doi: /j.scitotenv Purpose of the research: The present government in the Netherlands intends to realize a substantial growth of wind energy before 2020, both onshore and offshore. Wind turbines, when positioned in the neighborhood of residents may cause visual annoyance and noise annoyance. Studies on other environmental sound sources, such as railway, road traffic, industry and aircraft noise show that (long-term) exposure to sound can have negative effects other than annoyance from noise. This study aims to elucidate the relation between exposure to the sound of wind turbines and annoyance, selfreported sleep disturbance and psychological distress of people that live in their vicinity. Data were gathered by questionnaire that was sent by mail to a representative sample of residents of the Netherlands living in the vicinity of wind turbines Principal results: A dose response relationship was found between immission levels of wind turbine sound and self reported noise annoyance. Sound exposure was also related to sleep disturbance and psychological distress among those who reported that they could hear the sound, however not directly but with noise annoyance acting as a mediator. Respondents living in areas with other background sounds were less affected than respondents in quiet areas. Major conclusions: People living in the vicinity of wind turbines are at risk of being annoyed by the noise, an adverse effect in itself. Noise annoyance in turn could lead to sleep disturbance and psychological distress. No direct effects of wind turbine noise on sleep disturbance or psychological stress has been demonstrated, which means that residents, who do not hear the sound, or do not feel disturbed, are not adversely affected. Basner M, Brink M, Bristow A, de Kluizenaar Y, Finegold L, Hong J, Janssen SA, Klaeboe R, Leroux T, Liebl A, Matsui T, Schwela D, Sliwinska-Kowalska M, Sörqvist P. ICBEN review of research on the biological effects of noise Noise Health [serial online] 2015 [cited 2015 Mar 23 ];17:57-82 Available from: 2

3 : The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noiseinduced effects on human beings and animals. In this review, ICBEN team chairs and cochairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health. Bernert RA, and Joiner TE Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatr Dis Treat December; 3(6): PMCID: PMC A growing body of research indicates that sleep disturbances are associated with suicidal ideation and behaviors. This article provides a critical review of the extant literature on sleep and suicidality and addresses shared underlying neurobiological factors, biological and social zeitgebers, treatment implications, and future directions for research. Findings indicate that suicidal ideation and behaviors are closely associated with sleep complaints, and in some cases, this association exists above and beyond depression. Several cross-sectional investigations indicate a unique association between nightmares and suicidal ideation, whereas the relationship between insomnia and suicidality requires further study. Underlying neurobiological factors may, in part, account for the relationship between sleep and suicide. Serotonergic neurotransmission appears to play a critical role in both sleep and suicide. Finally, it remains unclear whether or not sleep-oriented interventions may reduce risk for suicidal behaviors. Unlike other suicide risk factors, sleep complaints may be particularly amenable to treatment. As a warning sign, disturbances in sleep may thus be especially useful to research and may serve as an important clinical target for future suicide intervention efforts. Bronzaft, Arline L. The Noise from Wind Turbines: Potential Adverse Impacts on Children's Well-Being Bulletin of Science Technology & Society : 256, DOI: / Research linking loud sounds to hearing loss in youngsters is now widespread, resulting in the issuance of warnings to protect children s hearing. However, studies attesting to the adverse effects of intrusive sounds and noise on children s overall mental and physical health and well-being have not received similar attention. This, despite the fact that many studies have demonstrated that intrusive noises such as those from passing road traffic, nearby rail systems, and overhead aircraft can adversely affect children s cardiovascular system, memory, language development, and learning acquisition. While some schools in the United States have received funds to abate intrusive aircraft noise, for example, many schools still expose children to noises from passing traffic and overhead aircraft. Discussion focuses on the harmful effects of noise on children, what has to be done to remedy the situation, and the need for action to lessen the impacts of noise from all sources. 3

4 Furthermore, based on our knowledge of the harmful effects of noise on children s health and the growing body of evidence to suggest the potential harmful effects of industrial wind turbine noise, it is strongly urged that further studies be conducted on the impacts of industrial wind turbines on their health, as well as the health of their parents, before forging ahead in siting industrial wind turbines. Enbom H and Enbom IM, Infrasound from wind turbines: An overlooked health hazard, Läkartidningen, vol. 110 (2013), pp : Infrasound from wind turbines affects the inner ear and is a potential health risk for people with migraine or other type of central nervous system. The authors maintain that the legal framework for the creation of new wind turbines should be revised, taking into account this fact. Previous scientific studies on wind turbines and infrasound have been contradictory. They have therefore not been sufficiently credible when planning a framework for the establishment of wind turbines. In recent years, however, a new insight has emerged on the central nervous system, providing a better understanding of migraine, fibromyalgia and other chronic pain syndromes and some cases of tinnitus and dizziness. This understanding is also important for understanding how infrasound from wind turbines can affect health. Several studies have found that living near wind turbines often create severe sleep disturbance and depression. They have also found an increased incidence of dizziness, tinnitus, hyperacusis, headache, increased activation of the autonomic nervous system, etc. Farboud, A.; Crunkhorn, R.; and Trinidade, A. Wind turbine syndrome: fact or fiction? Review Article The Journal of Laryngology & Otology, 1 of 5. JLO (1984) Limited, 2013, doi: /s Objective: Symptoms, including tinnitus, ear pain and vertigo, have been reported following exposure to wind turbine noise. This review addresses the effects of infrasound and low frequency noise and questions the existence of wind turbine syndrome. Design: This review is based on a search for articles published within the last 10 years, conducted using the PubMed database and Google Scholar search engine, which included in their title or abstract the terms wind turbine, infrasound or low frequency noise. Results: There is evidence that infrasound has a physiological effect on the ear. Until this effect is fully understood, it is impossible to conclude that wind turbine noise does not cause any of the symptoms described. However, many believe that these symptoms are related largely to the stress caused by unwanted noise exposure. Conclusion: There is some evidence of symptoms in patients exposed to wind turbine noise. The effects of infrasound require further investigation. There is ample evidence of symptoms arising in individuals exposed to wind turbine noise. Some researchers maintain that the effects of wind turbine syndrome are clearly just examples of the well known stress effects of exposure to noise, as displayed by a small proportion of the population. However, there is an increasing body of evidence suggesting that infrasound and low frequency noise have physiological effects on the ear. Until these effects are fully understood, it is impossible to state conclusively that exposure to wind turbine noise does not cause any of the symptoms described. The effects of infrasound and low frequency noise require further investigation. 4

5 Harrison, John P. Wind Turbine Noise Bulletin of Science Technology & Society : 256, DOI: / Following an introduction to noise and noise regulation of wind turbines, the problem of adverse health effects of turbine noise is discussed. This is attributed to the characteristics of turbine noise and deficiencies in the regulation of this noise. Both onshore and offshore wind farms are discussed. Havas, Magda and Colling, David Wind Turbines Make Waves: Why Some Residents Near Wind Turbines Become Ill Bulletin of Science Technology & Society : 414. DOI: / People who live near wind turbines complain of symptoms that include some combination of the following: difficulty sleeping, fatigue, depression, irritability, aggressiveness, cognitive dysfunction, chest pain/pressure, headaches, joint pain, skin irritations, nausea, dizziness, tinnitus, and stress. These symptoms have been attributed to the pressure (sound) waves that wind turbines generate in the form of noise and infrasound. However, wind turbines also generate electromagnetic waves in the form of poor power quality (dirty electricity) and ground current, and these can adversely affect those who are electrically hypersensitive. Indeed, the symptoms mentioned above are consistent with electrohypersensitivity. Sensitivity to both sound and electromagnetic waves differs among individuals and may explain why not everyone in the same home experiences similar effects. Ways to mitigate the adverse health effects of wind turbines are presented. Hanning, Christopher D. and Evans, Alun Editorial: Wind turbine noise British Medical Journal, BM J2 012;344 doi: / bmj.e1527 (8 March 2012) Except from BMJ web site: Seems to affect health adversely and an independent review of evidence is needed. The evidence for adequate sleep as a prerequisite for human health, particularly child health, is overwhelming. Governments have recently paid much attention to the effects of environmental noise on sleep duration and quality, and to how to reduce such noise. However, governments have also imposed noise from industrial wind turbines on large swathes of peaceful countryside. The impact of road, rail, and aircraft noise on sleep and daytime functioning (sleepiness and cognitive function) is well established. Shortly after wind turbines began to be erected close to housing, complaints emerged of adverse effects on health. Sleep disturbance was the main complaint. Such reports have been dismissed as being subjective and anecdotal, but experts contend that the quantity, consistency, and ubiquity of the complaints constitute epidemiological evidence of a strong link between wind turbine noise, ill health, and disruption of sleep. 5

6 Horner, Brett; Jeffery Roy D.; and Krogh, Carmen M. E. Literature Reviews on Wind Turbines and Health : Are They Enough? Bulletin of Science Technology & Society : 399. DOI: / Industrial wind turbines (IWTs) are a new source of community noise to which relatively few people have yet been exposed. IWTs are being erected at a rapid pace in proximity to human habitation. Some people report experiencing adverse health effects as a result of living in the environs of IWTs. In order to address public concerns and assess the plausibility of reported adverse health effects, a number of literature reviews have been commissioned by various organizations. This article explores some of the recent literature reviews on IWTs and adverse health effects. It considers the completeness, accuracy, and objectivity of their contents and conclusions. While some of the literature reviews provide a balanced assessment and draw reasonable scientific conclusions, others should not be relied on to make informed decisions. The article concludes that human health research is required to develop authoritative guidelines for the siting of IWTs in order to protect the health and welfare of exposed individuals. James, Richard R. Wind Turbine Infra and Low-Frequency Sound: Warnings Signs That Were Not Heard DOI: / Bulletin of Science Technology & Society published online 15 December Industrial wind turbines are frequently thought of as benign. However, the literature is reporting adverse health effects associated with the implementation of industrial-scale wind developments. This article explores the historical evidence about what was known regarding infra and low-frequency sound from wind turbines and other noise sources during the period from the 1970s through the end of the 1990s. This exploration has been accomplished through references, personal interviews and communications, and other available documentation. The application of past knowledge could improve the current siting of industrial wind turbines and avoid potential risks to health. Jeffery, Roy D.; Krogh, Carmen; and Horner, Brett Industrial wind turbines and adverse health effects Can J Rural Med 2014;19(1) Health is one of the fundamental rights of every human being. Some people exposed to IWTs experience negative effects to their physical, mental and social well-being. There is sufficient evidence to support the hypothesis of Colby and colleagues that documented symptoms can result from annoyance to audible IWTs. Amplitude modulation of IWTs, audible LFN, and tonal, impulse and nighttime noise can contribute to annoyance and other effects on health. In addition, there is emerging evidence that suggests inaudible LFN or infrasound from IWTs may result in negative health effects. Further research is required to clarify the exact role that sound characteristics, visual impacts, 6

7 stray voltage and socioeconomic impacts of IWTs may have on human health. As more IWTs are installed, rural physicians are likely to be presented with increasing numbers of patients who are adversely affected. Based on current knowledge, we expect that, at typical setback distances and sound pressure levels of IWTs in Ontario, a nontrivial percentage of exposed people will be adversely affected. Trade-offs of health for perceived benefit in alternate forms of energy can be prevented if setback distances and noise limits are developed using established noise management techniques. In addition to providing care for affected patients, rural physicians have a responsibility to advance understanding and to help inform IWT regulations that will protect the physical, mental and social well-being of patients. Jeffery, Roy D.; Krogh, Carmen; and Horner, Brett Adverse health effects of industrial wind turbines Can Fam Physician 2013; 59: (Commentary) Conclusion Industrial wind turbines can harm human health if sited too close to residents. Harm can be avoided if IWTs are situated at an appropriate distance from humans. Owing to the lack of adequately protective siting guidelines, people exposed to IWTs can be expected to present to their family physicians in increasing numbers. The documented symptoms are usually stress disorder type diseases acting via indirect pathways and can represent serious harm to human health. Family physicians are in a position to effectively recognize the ailments and provide an empathetic response. In addition, their contributions to clinical studies are urgently needed to clarify the relationship between IWT exposure and human health and to inform regulations that will protect physical, mental, and social well-being. Jeffery, Roy D.; Krogh, Carmen; and Horner, Brett Adverse health effects of industrial wind turbines Can Fam Physician 2013; 59: (Letter to the Editor) Conclusion Mr Barnard writes that health effects are related to the negative attitude of the individual exposed to IWTs. Some researchers have found that the IWTs were initially welcomed into communities for their perceived economic or environmental benefits. The reported adverse impacts were unexpected. The 2011 Ontario Real Estate Association Form 220 (Seller Property Information Statement) requires disclosure of environmental issues when selling residential property, including toxic waste, soil contamination, landfills, and wind turbines planned for the immediate area. The adverse health effects of audible and inaudible noise are substantial. Their effects are underestimated and underappreciated by some. We are guided by the references and the desire to safeguard the health and wellbeing of those living in the environs of IWTs. Harm can be avoided by placing IWTs at a protective distance from residents. The acknowledgment that health effects occur in some is an important step toward achieving this goal. Krogh, Carmen M.E. Industrial Wind Turbine Development and Loss of Social Justice? Bulletin of Science Technology & Society : 321, DOI: / , 7

8 This article explores the loss of social justice reported by individuals living in the environs of industrial wind turbines (IWTs). References indicate that some individuals residing in proximity to IWT facilities experience adverse health effects. These adverse health effects are severe enough that some families have abandoned their homes. Individuals report they welcomed IWTs into their community and the negative consequences were unexpected. Expressions of grief are exacerbated by the emotional and physical toll of individuals symptoms, loss of enjoyment of homes and property, disturbed living conditions, financial loss, and the lack of society s recognition of their situation. The author has investigated the reported loss of social justice through a review of literature, personal interviews with, and communications from, those reporting adverse health effects. The author s intention is to create awareness that loss of social justice is being associated with IWT development. This loss of justice arises from a number of factors, including the lack of fair process, the loss of rights, and associated disempowerment. These societal themes require further investigation. Research by health professionals and social scientists is urgently needed to address the health and social impacts of IWTs operating near family homes. Krogh, Carmen M.E.; Gillis, Lorrie; Kouwen, Nicholas; and Aramini, Jeffery WindVOiCe, a Self-Reporting Survey: Adverse Health Effects, Industrial Wind Turbines, and the Need for Vigilance Monitoring Bulletin of Science Technology & Society : 334, DOI: / , Industrial wind turbines have been operating in many parts of the globe. Anecdotal reports of perceived adverse health effects relating to industrial wind turbines have been published in the media and on the Internet. Based on these reports, indications were that some residents perceived they were experiencing adverse health effects. The purpose of the WindVOiCe health survey was to provide vigilance monitoring for those wishing to report their perceived adverse health effects. This article discusses the results of a self reporting health survey regarding perceived adverse health effects associated with industrial wind turbines. Robert Y McMurtry and Carmen ME Krogh Diagnostic criteria for adverse health effects in the environs of wind turbines DOI: / JRSM Open PMID: [PubMed] PMCID: PMC effects+in+the+environs+of+wind+turbines Summary In an effort to address climate change, governments have pursued policies that seek to reduce greenhouse gases. Alternative energy, including wind power, has been proposed by some as the preferred approach. Few would debate the need to reduce air pollution, but the means of achieving this reduction is important not only for efficiency but also for health protection. The topic of adverse health effects in the environs of industrial wind turbines (AHE/IWT) has proven to be controversial and can present physicians with challenges regarding the management of an exposure to IWT. Rural physicians in particular must be aware of the possibility of people presenting to their practices 8

9 with a variety of sometimes confusing complaints. An earlier version of the diagnostic criteria for AHE/IWT was published in August A revised case definition and a model for a study to establish a confirmed diagnosis is proposed. McMurtry, Robert Y. Toward a Case Definition of Adverse Health Effects in the Environs of Industrial Wind Turbines: Facilitating a Clinical Diagnosis Bulletin of Science Technology & Society : 316, DOI: / , Internationally, there are reports of adverse health effects (AHE) in the environs of industrial wind turbines (IWT). There was multidisciplinary confirmation of the key characteristics of the AHE at the first international symposium on AHE/IWT. The symptoms being reported are consistent internationally and are characterized by crossover findings or a predictable appearance of signs and symptoms present with exposure to IWT sound energy and amelioration when the exposure ceases. There is also a revealed preference of victims to seek restoration away from their homes. This article identifies the need to create a case definition to establish a clinical diagnosis. A case definition is proposed that identifies the sine qua non diagnostic criteria for a diagnosis of adverse health effects in the environs of industrial wind turbines. Possible, probable, and confirmed diagnoses are detailed. The goal is to foster the adoption of a common case definition that will facilitate future research efforts. Kugler K,Wiegrebe L,Grothe B, Kössl M, Gürkov R, Krause E, Drexl M. Low-frequency sound affects active micromechanics in the human inner ear. R. Soc. open sci. 1: Conclusion The results of this study clearly indicate that there is a pronounced discrepancy between the unobtrusive perception of LF sound, reflected in their low sensation levels and the physiological responses of the cochlea following the LF sound exposure. To the best of our knowledge, perception has been the only measure available in humans to assess inner ear responses to very LF sound, but, as the current data show, severely underestimates cochlear and, especially OHC, sensitivity. Direct quantifications of inner ear active amplification, as measured in this study, are much better suited to assess the risk potential of LF sound. Möller-Levet CS; Archer SN; Bucca, G; Laing EE; Slak A; Kabiljo R; Lo JCY.; Santhi N; von Schantz M; Smith CP.; and Derk-Jan D Effects of insufficient sleep on circadian rhythmicity and expression amplitude of the human blood transcriptome Published online before print February 25, 2013, doi: /pnas PNAS (Proceedings of the National Academy of Sciences) February 25, (Excerpt) Insufficient sleep and circadian rhythm disruption are associated with negative health outcomes, including obesity, cardiovascular disease, and cognitive impairment, but the mechanisms involved 9

10 remain largely unexplored Biological processes affected included chromatin modification, geneexpression regulation, macromolecular metabolism, and inflammatory, immune and stress responses. Thus, insufficient sleep affects the human blood transcriptome, disrupts its circadian regulation, and intensifies the effects of acute total sleep deprivation. The identified biological processes may be involved with the negative effects of sleep loss on health, and highlight the interrelatedness of sleep homeostasis, circadian rhythmicity, and metabolism. Møller, Henrik and Pedersen, Christian Sejer Low-frequency noise from large wind turbines Section of Acoustics, Aalborg University, Denmark, Acoustical Society of America [DOI: / ] J. Acoust. Soc. Am. 129 (6), June 2011 PACS number(s): Rq, Hr, Cb, Sr [ADP] Pages: As wind turbines get larger, worries have emerged that the turbine noise would move down in frequency and that the low-frequency noise would cause annoyance for the neighbors. The noise emission from 48 wind turbines with nominal electric power up to 3.6 MW is analyzed and discussed. The relative amount of low-frequency noise is higher for large turbines ( MW) than for small turbines ( 2 MW), and the difference is statistically significant. The difference can also be expressed as a downward shift of the spectrum of approximately one-third of an octave. A further shift of similar size is suggested for future turbines in the 10-MW range. Due to the air absorption, the higher low-frequency content becomes even more pronounced, when sound pressure levels in relevant neighbor distances are considered. Even when A-weighted levels are considered, a substantial part of the noise is at low frequencies, and for several of the investigated large turbines, the one-third-octave band with the highest level is at or below 250 Hz. It is thus beyond any doubt that the low-frequency part of the spectrum plays an important role in the noise at the neighbors. Munzel T, Goril T, Babisch W, Basner M, Cardiovascular effects of environmental noise exposure. European Heart Journal (2014) 35, doi: /eurheartj/ehu030 Summary The role of noise as an environmental pollutant and its impact on health are being increasingly recognized. Beyond its effects on the auditory system, noise causes annoyance and disturbs sleep, and it impairs cognitive performance. Furthermore, evidence from epidemiologic studies demonstrates that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, and stroke. Both observational and experimental studies indicate that in particular night-time noise can cause disruptions of sleep structure, vegetative arousals (e.g. increases of blood pressure and heart rate) and increases in stress hormone levels and oxidative stress, which in turn may result in endothelial dysfunction and arterial hypertension. This review focuses on the cardiovascular consequences of environmental noise exposure and stresses the importance of noise mitigation strategies for public health. Conclusions Taken together, the present review provides evidence that noise not only causes annoyance, sleep disturbance, or reductions in quality of life, but also contributes to a higher prevalence of the most important cardiovascular risk factor arterial hypertension and the incidence of cardiovascular diseases. The evidence supporting such contention is based on an established rationale supported by experimental laboratory and observational field studies, and a number of epidemiological studies. Meta-analyses have been carried out to derive exposure response relationships that can be used for 10

11 quantitative health impact assessments. Noise-induced sleep disturbance constitutes an important mechanism on the pathway from chronic noise exposure to the development of adverse health effects. The results call for more initiatives aimed at reducing environmental noise exposure levels to promote cardiovascular and public health. Recent studies indicate that people s attitude and awareness in particular towards aircraft noise has changed over the years. Noise mitigation policies have to consider the medical implications of environmental noise exposure. Noise mitigation strategies to improve public health include noise reduction at the source, active noise control (e.g. noise optimized take-off and approach procedures), optimized traffic operations (including traffic curfews), better infrastructural planning, better sound insulation in situations where other options are not feasible, and adequate limit values. Nissenbaum, Michael A.; Aramini, Jeffery J.; and Hanning, Christopher D. Effects of industrial wind turbine noise on sleep and health Noise & Health, September-October 2012, Volume 14, p243 Industrial wind turbines (IWTs) are a new source of noise in previously quiet rural environments. Environmental noise is a public health concern, of which sleep disruption is a major factor. To compare sleep and general health outcomes between participants living close to IWTs and those living further away from them, participants living between 375 and 1400 m (n= 38) and 3.3 and 6.6 km (n = 41) from IWTs were enrolled in a stratified cross-sectional study involving two rural sites. Validated questionnaires were used to collect information on sleep quality (Pittsburgh Sleep Quality Index PSQI), daytime sleepiness (Epworth Sleepiness Score ESS), and general health (SF36v2), together with psychiatric disorders, attitude, and demographics. Descriptive and multivariate analyses were performed to investigate the effect of the main exposure variable of interest (distance to the nearest IWT) on various health outcome measures. Participants living within 1.4 km of an IWT had worse sleep, were sleepier during the day, and had worse SF36 Mental Component Scores compared to those living further than 1.4 km away. Significant dose-response relationships between PSQI, ESS, SF36 Mental Component Score, and log-distance to the nearest IWT were identified after controlling for gender, age, and household clustering. The adverse event reports of sleep disturbance and ill health by those living close to IWTs are supported. Persinger, Michael A. Infrasound, human health, and adaptation: an integrative overview of recondite hazards in a complex environment Nat Hazards DOI /s This article is published with open access at Conclusion Living systems, including the human species, have evolved within a natural environment whose properties are complex but not intractable to measurement and understanding. Although the partitioning of the formal description of natural phenomena by different scientific disciplines may have satisfied the conditions of human cognition, the subsequent traditions may have obscured the essential relationships between human adaptation and the natural environment that is optimally discerned through true interdisciplinary approaches. Human beings can be described as both mechanical and energetic organisms. There are 11

12 multiple sources of stimuli that exhibit energetic equivalents whose values in turn converge with those essential for the function of the cell, the organ, and the organism. The frequencies that have been defined as infrasound, from natural, manufactured, and as yet unknown sources, have the capacity to resonate with the human body. This review of the scientific literature and the quantitative illustrations derived from the systematic application of known principles may facilitate the acquisition of the precision required to differentiate between natural hazards and natural benefits rather than depending primarily upon political and social agendas. Phillips, Carl V. Properly Interpreting the Epidemiologic Evidence About the Health Effects of Industrial Wind Turbines on Nearby Residents Bulletin of Science Technology & Society : 303, DOI: / , There is overwhelming evidence that wind turbines cause serious health problems in nearby residents, usually stress-disorder type diseases, at a nontrivial rate. The bulk of the evidence takes the form of thousands of adverse event reports. There is also a small amount of systematically gathered data. The adverse event reports provide compelling evidence of the seriousness of the problems and of causation in this case because of their volume, the ease of observing exposure and outcome incidence, and case-crossover data. Proponents of turbines have sought to deny these problems by making a collection of contradictory claims including that the evidence does not count, the outcomes are not real diseases, the outcomes are the victims own fault, and that acoustical models cannot explain why there are health problems so the problems must not exist. These claims appeared to have swayed many nonexpert observers, though they are easily debunked. Moreover, though the failure of models to explain the observed problems does not deny the problems, it does mean that we do not know what, other than kilometers of distance, could sufficiently mitigate the effects. There has been no policy analysis that justifies imposing these effects on local residents. The attempts to deny the evidence cannot be seen as honest scientific disagreement and represent either gross incompetence or intentional bias. Punch, Jerry; James, Rick; and Pabst, Dan Wind-Turbine Noise What Audiologists Should Know Audiology Today, July/August 2010 Conclusion Our purpose in this article has been to provide audiologists with a better understanding of the types of noise generated by wind turbines, some basic considerations underlying sound-level measurements of wind-turbine noise, and the adverse health effects on people who live near these turbines. In future years, we expect that audiologists will be called upon to make noise measurements in communities that have acquired wind turbines, or are considering them. Some of us, along with members of the medical profession, will be asked to provide legal testimony regarding our opinions on the effects of such noise on people. Many of us will likely see clinical patients who are experiencing some of the adverse health effects described in this article. As a professional community, audiologists should become involved not only in making these measurements to corroborate the complaints of residents living near wind-turbine projects but also in developing and shaping siting guidelines that minimize the potentially adverse health effects of the noise and vibration they generate. In these ways, we can promote public health interests without opposing the use of wind turbines as a desirable and viable alternative energy source. 12

13 Rand, Robert W.; Ambrose, Stephen E.; and Krogh, Carmen M. E. Occupational Health and Industrial Wind Turbines: A Case Study Bulletin of Science Technology & Society : 359DOI: / Industrial wind turbines (IWTs) are being installed at a fast pace globally. Researchers, medical practitioners, and media have reported adverse health effects resulting from living in the environs of IWTs. While there have been some anecdotal reports from technicians and other workers who work in the environs of IWTs, little is known about the occupational health sector. The purpose of this case study is to raise awareness about the potential for adverse health effects occurring among workers. The authors propose that there is a need for research regarding occupational worker exposure relating to IWTs. Salt, Alec N. and Hullar, T.E. Responses of the ear to low frequency sounds, infrasound and wind turbines. Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, 63110, USA. Hearing Research 2010 Sep 1; 268(1-2): Epub 2010 Jun 16 Infrasonic sounds are generated internally in the body (by respiration, heartbeat, coughing, etc) and by external sources, such as air conditioning systems, inside vehicles, some industrial processes and, now becoming increasingly prevalent, wind turbines. It is widely assumed that infrasound presented at an amplitude below what is audible has no influence on the ear. In this review, we consider possible ways that low frequency sounds, at levels that may or may not be heard, could influence the function of the ear. The inner ear has elaborate mechanisms to attenuate low frequency sound components before they are transmitted to the brain. The auditory portion of the ear, the cochlea, has two types of sensory cells, inner hair cells (IHC) and outer hair cells (OHC), of which the IHC are coupled to the afferent fibers that transmit "hearing" to the brain. The sensory stereocilia ("hairs") on the IHC are "fluid coupled" to mechanical stimuli, so their responses depend on stimulus velocity and their sensitivity decreases as sound frequency is lowered. In contrast, the OHC are directly coupled to mechanical stimuli, so their input remains greater than for IHC at low frequencies. At very low frequencies the OHC are stimulated by sounds at levels below those that are heard. Although the hair cells in other sensory structures such as the saccule may be tuned to infrasonic frequencies, auditory stimulus coupling to these structures is inefficient so that they are unlikely to be influenced by airborne infrasound. Structures that are involved in endolymph volume regulation are also known to be influenced by infrasound, but their sensitivity is also thought to be low. There are, however, abnormal states in which the ear becomes hypersensitive to infrasound. In most cases, the inner ear's responses to infrasound can be considered normal, but they could be associated with unfamiliar sensations or subtle changes in physiology. This raises the possibility that exposure to the infrasound component of wind turbine noise could influence the physiology of the ear. Salt, Alec N. and Kaltenbach, James A. Infrasound From Wind Turbines Could Affect Humans Bulletin of Science Technology & Society : 296, DOI: /

14 Wind turbines generate low-frequency sounds that affect the ear. The ear is superficially similar to a microphone, converting mechanical sound waves into electrical signals, but does this by complex physiologic processes. Serious misconceptions about low-frequency sound and the ear have resulted from a failure to consider in detail how the ear works. Although the cells that provide hearing are insensitive to infrasound, other sensory cells in the ear are much more sensitive, which can be demonstrated by electrical recordings. Responses to infrasound reach the brain through pathways that do not involve conscious hearing but instead may produce sensations of fullness, pressure or tinnitus, or have no sensation. Activation of subconscious pathways by infrasound could disturb sleep. Based on our current knowledge of how the ear works, it is quite possible that low-frequency sounds at the levels generated by wind turbines could affect those living nearby. Schomer PD, Erdreich J, Pamidighantam KP, and Boyle JH, February 2015) A theory to explain some physiological effects of the infrasonic emissions at some wind farm sites J. Acoust. Soc. Am. 137 (3), March For at least four decades, there have been reports in scientific literature of people experiencing motion sickness-like symptoms attributed to low-frequency sound and infrasound. In the last several years, there have been an increasing number of such reports with respect to wind turbines; this corresponds to wind turbines becoming more prevalent. A study in Shirley, WI, has led to interesting findings that include: (1) To induce major effects, it appears that the source must be at a very low frequency, about 0.8 Hz and below with maximum effects at about 0.2 Hz; (2) the largest, newest wind turbines are moving down in frequency into this range; (3) the symptoms of motion sickness and wind turbine acoustic emissions sickness are very similar; (4) and it appears that the same organs in the inner ear, the otoliths may be central to both conditions. Given that the same organs may produce the same symptoms, one explanation is that the wind turbine acoustic emissions may, in fact, induce motion sickness in those prone to this affliction. Seltenrich, Nate Wind Turbines A Different Breed of Noise? Environmental Health Perspectives, volume 122 number 1 January 2014 Looking Long Term The gold standard for proving causality of an exposure is the randomized clinical trial. But when it comes to testing the health effects of noise exposure on humans, such a study design is likely to be not only impractical and difficult to implement, but also unethical. The next-best evidence would come from longitudinal field research, many researchers agree, such as long-term studies that assess the health of a community before a turbine project is ever proposed and then continue to follow up during operation. Lercher notes that some effects of chronic noise exposure such as elevated blood pressure could take one or two decades to manifest at significant levels. Most of the studies performed to date around both transportation and wind-farm sources have been cross-sectional, which makes it impossible to assess causality. That s because investigators cannot establish whether the potential cause precedes the potential effect. Lercher stresses that cross- 14

15 sectional studies purporting to demonstrate a relationship between noise exposures and health effects may be averaging out potential effects that are only visible in some subgroups e.g., those with certain medical risk factors, or those exposed to the noise for longer than others. Shain, Martin, Public Health Ethics, Legitimacy, and the Challenges of Industrial Wind Turbines: The Case of Ontario, CanadaBulletin of Science Technology & Society, : 256 DOI: / , While industrial wind turbines (IWTs) clearly raise issues concerning threats to the health of a few in contrast to claimed health benefits to many, the trade-off has not been fully considered in a public health framework. This article reviews public health ethics justifications for the licensing and installation of IWTs. It concludes that the current methods used by government to evaluate licensing applications for IWTs do not meet most public health ethical criteria. Furthermore, these methods are contrary to widely held fundamental principles of administrative law and governmental legitimacy. A set of decision-making principles are suggested to address this situation that are derived from existing and emerging legal principles in Canada and elsewhere. These include the Precautionary Principle, the Least Impactful Means (Proportionality) Test, and the Neighbor Principle. Shepherd, Daniel; Welch, David; Dirks, Kim N.; and McBride, David (March 2013) Do Quiet Areas Afford Greater Health-Related Quality of Life than Noisy Areas? International Journal of Environmental Research and Public Health, ISSN : People typically choose to live in quiet areas in order to safeguard their health and wellbeing. However, the benefits of living in quiet areas are relatively understudied compared to the burdens associated with living in noisy areas. Additionally, research is increasingly focusing on the relationship between the human response to noise and measures of health and wellbeing, complementing traditional dose-response approaches, and further elucidating the impact of noise and health by incorporating human factors as mediators and moderators. To further explore the benefits of living in quiet areas, we compared the results of health-related quality of life (HRQOL) questionnaire datasets collected from households in localities differentiated by their soundscapes and population density: noisy city, quiet city, quiet rural, and noisy rural. The dose-response relationships between noise annoyance and HRQOL measures indicated an inverse relationship between the two. Additionally, quiet areas were found to have higher mean HRQOL domain scores than noisy areas. This research further supports the protection of quiet locales and ongoing noise abatement in noisy areas. Shepherd D, Hanning C, Thorne B. Noise: Windfarms (2012) Published in the Encyclopedia of Environmental Management (peer review panel for all articles) DOI: /E-EEM : Windfarms consist of clusters of wind turbines, which, when placed in populated areas, are associated with intrusive and unwanted sound. A relatively new noise source; wind turbine noise has characteristics sufficiently different from other, more extensively studied, noise sources to suggest that preexisting noise standards are not appropriate. Though research into the human impacts of wind turbine noise has appeared only in the last decade and in small quantity, the data suggest that, for equivalent exposures, wind turbine noise is more annoying than road or aviation noise. Furthermore, 15

16 the particular characteristics of wind turbine noise may be likely to cause sleep disruption. As with other impulsive noise sources, time-aggregated noise metrics have limited utility in protecting public health, and a cluster of metrics should be used in order to estimate potential threat. At this time, however, the quantity and quality of research are insufficient to effectively describe the relationship between wind turbine noise and health, and so legislation should apply the precautionary principle or conservative criteria when assessing proposed windfarm developments. Shepherd, Daniel and Billington, Rex Mitigating the Acoustic Impacts of Modern Technologies: Acoustic, Health, and Psychosocial Factors Informing Wind Farm Placement Bulletin of Science Technology & Society : 389 DOI: / Wind turbine noise is annoying and has been linked to increased levels of psychological distress, stress, difficulty falling asleep and sleep interruption. For these reasons, there is a need for competently designed noise standards to safeguard community health and well-being. The authors identify key considerations for the development of wind turbine noise standards, which emphasize a more social and humanistic approach to the assessment of new energy technologies in society. Shepherd, Daniel; McBride, David; Welch; Dirks, Kim N.; and Hill Erin M. Evaluating the impact of wind turbine noise on health related quality of life Noise & Health, September-October 2011, 13:54,333-9 DOI: / We report a cross-sectional study comparing the health-related quality of life (HRQOL) of individuals residing in the proximity of a wind farm to those residing in a demographically matched area sufficiently displaced from wind turbines. The study employed a nonequivalent comparison group posttest-only design. Self-administered questionnaires, which included the brief version of the World Health Organization quality of life scale, were delivered to residents in two adjacent areas in semirural New Zealand. Participants were also asked to identify annoying noises, indicate their degree of noise sensitivity, and rate amenity. Statistically significant differences were noted in some HRQOL domain scores, with residents living within 2 km of a turbine installation reporting lower overall quality of life, physical quality of life, and environmental quality of life. Those exposed to turbine noise also reported significantly lower sleep quality, and rated their environment as less restful. Our data suggest that wind farm noise can negatively impact facets of HRQOL. Acknowledgements: We are grateful to our colleagues and others whose reviews substantially improved the manuscript. We are especially grateful for the thorough review undertaken by Professor Rex Billington, who as the WHO Director of Mental Health in the 1990s oversaw the development of the WHO s program into quality of life, health and the environment. 16

17 Thorne R, and Shepherd D, Quiet as an Environmental Value: A Contrast between Two Legislative Approaches. Int. J. Environ. Res. Public Health 2013, 10 This paper examines the concept of quiet as an environmental value in terms of amenity and wellbeing from a legislative context. Critical review of two pieces of environmental legislation from Australia and New Zealand forms the basis of the paper. The Australian legislation is Queensland s Environmental Protection Act, and the New Zealand legislation is that nation s Resource Management Act. Quiet is part of the psychoacoustic continuum between a tranquil and an intrusively noisy sound environment. As such, quiet possesses intrinsic value in terms of overall sound within the environment (soundscape) and to individuals and communities. In both pieces of legislation, guidance, either directly or indirectly, is given to maximum sound levels to describe the acoustic environment. Only in Queensland is wellbeing and amenity described as environmental values, while in the New Zealand approach, amenity is identified as the core value to defend, but guidance is not well established. Wellbeing can be related to degrees of quietness and the absence of intrusive noise, the character of sound within an environment ( soundscape ), as well as the overall level of sound. The quality of life experienced by individuals is related to that person s physical and mental health, sense of amenity and wellbeing. These characteristics can be described in terms of subjective and objective measures, though legislation does not always acknowledge the subjective. Thorne, Bob The Problems With ''Noise Numbers'' for Wind Farm Noise Assessment Bulletin of Science Technology & Society : 262 DOI: / , Human perception responds primarily to sound character rather than sound level. Wind farms are unique sound sources and exhibit special audible and inaudible characteristics that can be described as modulating sound or as a tonal complex. Wind farm compliance measures based on a specified noise number alone will fail to address problems with noise nuisance. The character of wind farm sound, noise emissions from wind farms, noise prediction at residences, and systemic failures in assessment processes are examined. Human perception of wind farm sound is compared with noise assessment measures and complaint histories. The adverse effects on health of persons susceptible to noise from wind farms are examined and a hypothesis, the concept of heightened noise zones (pressure variations), as a marker for cause and effect is advanced. A sound level of LAeq 32 db outside a residence and above an individual s threshold of hearing inside the home are identified as markers for serious adverse health effects affecting susceptible individuals. The article is referenced to the author s research, measurements, and observations at different wind farms in New Zealand and Victoria, Australia. OTHER: Cooper S,The Results of an Acoustical Testing Program Cape Bridgewater Wind Farm, Prepared for Energy Pacific (Vic) Pty, Ltd Link to report and appendices: 17

18 Steven Cooper, acoustician from Australia. Conducted a study and as a result of the study design, the exhaustive infrasound (typically inaudible) measurements, the detailed diaries kept by the families, and the developer s (Pacific Hydro) cooperation, this study has advanced the understanding of the role of infrasound and human responses associated with industrial wind turbines. The link to report and appendices: Reviews of the study by members of the international community can be viewed at the Waubra Foundation web site: Howell G, Shubat D, and Krogh C., (January 2015) Autism and the effect of introducing a new noise source into quiet rural communities: risk factor from industrial wind power generation. Western University: From the Selected Works of Grace L Howell Faculty of Education Western University Background and Objectives Some individuals with Autism Spectrum Disorders (ASD) may react negatively to noise including low-frequency noise, infrasound, vibration and other environmental emissions. There are specific concerns in the Province of Ontario, Canada, related to the exposure of people with autism to the environmental noise and infrasound produced by an additional noise source, in this case from the introduction of industrial-scale wind turbines into quiet rural communities. The objective of this report is to explore the potential for effects of exposure to a new noise source on this specific and vulnerable population. There is a significant research gap regarding the impact of the introduction of industrial-scale power generation from wind into rural communities and on children with ASD. The additional noise and low-frequency sound produced by the wind turbines may add to the burden of environmental noise that the ASD population is already coping with, including exposures at home and at school. Front-line professionals such as educators and health care workers need to be aware of this possibility. Salt AN and Lichtenhan JT, How Does Wind Turbine Noise Affect People? Acoustics Today. A publication of the Acoustical Society of America. Volume 10: Issue One: Winter 2014 Conclusions and Concerns We have described multiple ways in which infrasound and low-frequency sounds could affect the ear and give rise to the symptoms that some people living near wind turbines report. If, in time, the symptoms of those living near the turbines are demonstrated to have a physiological basis, it will become apparent that the years of assertions from the wind industry s acousticians that what you can t hear can t affect you or that symptoms are psychosomatic or a nocebo effect was a great injustice. The current highly-polarized situation has arisen because our understanding of the 18

19 consequences of long-term infrasound stimulation remains at a very primitive level. Based on wellestablished principles of the physiology of the ear and how it responds to very low-frequency sounds, there is ample justification to take this problem more seriously than it has been to date. There are many important scientific issues that can only be resolved through careful and objective research. Although infrasound generation in the laboratory is technically difficult, some research groups are already in the process of designing the required equipment to perform controlled experiments in humans. One area of concern is the role that some acousticians and societies of acousticians have played. The primary role of acousticians should be to protect and serve society from negative influences of noise exposure. In the case of wind turbine noise, it appears that many have been failing in that role. For years, they have sheltered behind the mantra, now shown to be false, that has been presented repeatedly in many forms such as What you can t hear, can t affect you. ; If you cannot hear a sound you cannot perceive it in other ways and it does not affect you. ; Infrasound from wind turbines is below the audible threshold and of no consequence. ; Infrasound is negligible from this type of turbine. ; I can state categorically that there is no significant infrasound from current designs of wind turbines. All of these statements assume that hearing, derived from low-frequencyinsensitive IHC responses, is the only mechanism by which low frequency sound can affect the body. We know this assumption is false and blame its origin on a lack of detailed understanding of the physiology of the ear. Another concern that must be dealt with is the development of wind turbine noise measurements that have clinical relevance. The use of A-weighting must be reassessed as it is based on insensitive, IHCmediated hearing and grossly misrepresents inner ear stimulation generated by the noise. In the scientific domain, A-weighting sound measurements would be unacceptable when many elements of the ear exhibit a higher sensitivity than hearing. The wind industry should be held to the same high standards. Full-spectrum monitoring, which has been adopted in some reports, is essential. In the coming years, as we experiment to better understand the effects of prolonged low-frequency sound on humans, it will be possible to reassess the roles played by acousticians and professional groups who partner with the wind industry. Given the present evidence, it seems risky at best to continue the current gamble that infrasound stimulation of the ear stays confined to the ear and has no other effects on the body. For this to be true, all the mechanisms we have outlined (low frequencyinduced amplitude modulation, low frequency sound-induced endolymph volume changes, infrasound stimulation of type II afferent nerves, infrasound exacerbation of noise-induced damage and direct infrasound stimulation of vestibular organs) would have to be insignificant. We know this is highly unlikely and we anticipate novel findings in the coming years that will influence the debate. From our perspective, based on our knowledge of the physiology of the ear, we agree with the insight of Nancy Timmerman that the time has come to acknowledge the problem and work to eliminate it. A Cooperative Measurement Survey and Analysis of Low Frequency and Infrasound at the Shirley Wind Farm in Brown County, Wisconsin Report Number Issued: December 24, 2012 Excerpted 19

20 The Brown County Board of Health continued with its investigation and on October 14, 2014 Dr. Jay Tibbetts, member of the Brown County Board of Health states that the Brown Co. Board of Health's meeting of unanimously approved a motion to declare the Shirley Wind turbines to be a human health hazard. [Ref: Brown County Board of Health, Proceedings of the Board of Health Meeting, Tuesday, October 14, 2014, 5:00 PM] Editor: Bob Thorne, Noise Measurement Services Pty Ltd Wind Farm Noise Review April 2013 PREAMBLE There is significant body of peer-reviewed research readily available in the public forum to substantiate the potential for serious to moderate adverse health effects to individuals due to wind farm activity noise while living in their residences and while working on their farms near large-scale wind farms or large turbines. Adverse health effects can arise from extreme psychological stress from environmental noise, particularly low frequency noise with symptoms of sleep disturbance, headache, tinnitus, ear pressure, dizziness, vertigo, nausea, visual blurring, tachycardia, irritability, problems with concentration and memory, and panic attack episodes associated with such sensations when awake or asleep. The hypothesis from this Review is that serious harm to health occurs when a susceptible individual is so beset by the noise in question that he or she suffers recurring sleep disturbance, anxiety and stress. Research for the Review suggests that 5% to 10% of the individuals living in the vicinity of a large wind farm will experience serious harm to their health. The observed markers for serious health effects are (a) wind farm noise level of LAeq 32 db or more outside the residence and (b) wind farm noise is heard or is perceptible (felt) at levels above the individual s threshold of hearing inside the home Meteorological conditions, wind turbine spacing and associated wake and turbulence effects, vortex effects, wind shear, turbine synchronicity, tower height, blade length, and power settings all contribute to sound levels heard or perceived at residences. Wind farms are unique sound sources and exhibit special audible characteristics that can be described as modulating sound or as a tonal complex. Current noise prediction models are simplistic, have a high degree of uncertainty, and do not make allowance for these significant variables. Compliance monitoring must therefore include 20